In It Together: National Health Literacy Project for Black MSM Training of Trainers Module 6: Electronic Communication and eHealth Literacy

Welcome Trainer: Daniel Driffin Phone: This material was produced by John Snow Inc., under Contract #HHSH I with the Health Resources and Services Administration, U.S. Department of Health and Human Services.

Recap of Module 5 and take-away activity 1.Which health literacy principles were evident in the material you reviewed? 2.Which health literacy principles were missing from the material you reviewed? 3

Training goal Trainers will increase their understanding of today’s information environment, and the importance of eHealth literacy. Trainers will also be able to identify social media platforms they can use to engage Black MSM with limited health literacy. 4

Objectives of this training module By the end of this training, you will be able to:  Define eHealth literacy  Understand how electronic health literacy differs from traditional health literacy  Explain how Black MSM engage with technology and the internet  State 3 strategies to improve online communication with Black MSM 5

TODAY’S INFORMATION ENVIRONMENT 6

Changing Landscape for Health Information Traditional Information Exchange  In person from their health care provider  By talking to their family and friends  Through newspapers, magazines, books, radio, and television programs 7

Changing Landscape for Health Information Web 1.0 Web 2.0 8

Changing Landscape for Health Information Web 2.0 9

Types of Health Technology  EHRs  Touchscreen kiosks  Telehealth  Internet websites  Information  Communication  Mobile technology  Text messages  Smartphone apps  Online communication 10

IMPORTANCE OF HEALTH LITERACY IN ELECTRONIC COMMUNICATION 11

Source: Pew Research Center’s Internet & American Life Project, August 7-September 6, 2012 Survey. N=3,014 adults. Margin of error for internet users (N=2,392) is +/- 2.6 percentage points. 12 Internet Users Supplement Information They Get from Health Professionals

Improving Uptake and Utilization of Electronic Health Information is a National Priority: Healthy People 2020 #MeasureBaselineTarget 5.1Increase the proportion of persons who use the internet to keep track of personal health information, such as care received, test results, or upcoming medical appointments 14.3%15.7% 5.2Increase the proportion of persons who use the internet to communicate with their health provider 13.6%15% 6.1Increase the proportion of persons with access to the internet68.5%75.4% 6.2Increase the proportion of persons with broadband access to the internet 75.6%83.2% 6.3Increase the proportion of persons who use mobile devices10% ↑ 8.1Increase the proportion of health-related websites that meet three or more evaluation criteria for disclosing information that can be used to assess information reliability 58%70.5% 8.2Increase the proportion of health-related websites that follow established usability principles 42%55.7% 9Increase the proportion of online health information seekers who report easily accessing health information 37.3%41% 10Increase the proportion of medical practices that use electronic health records 25%27.5% 13

eHEALTH LITERACY 14

The ability to seek, find, understand, and assess health information from electronic sources and apply the knowledge gained to address or solve a health problem. 15 eHealth Literacy Norman, C. D., & Skinner, H. A. (2006). eHEALS: the eHealth literacy scale. Journal of medical Internet research, 8(4).

Components of eHealth Literacy 16

Components of eHealth Literacy 17

Components of eHealth Literacy 18

Components of eHealth Literacy 19

Components of eHealth Literacy 20

Components of eHealth Literacy 21

Components of eHealth Literacy 22

Components of eHealth Literacy 23 Traditional Literacy Health Literacy Information Literacy Scientific Literacy Media Literacy Computer Literacy

Changing Health Technology Landscape: Opportunities  Increased availability and access to health information  Access and management of their own health care information  Learning opportunities that are multisensory and interactive 24 Eichner, J., & Dullabh, P. (2007). Accessible health information technology (health IT) for populations with limited literacy: A guide for developers and purchasers of health IT. Rockville, MD: Agency for Healthcare Research and Quality.

Changing Health Technology Landscape: Challenges  Over 65% of the web’s content is in English  People without access to computers/internet may not have adequate eHealth literacy  Inequitable access to information  Health professionals may assume that everyone has access to the internet  It can be difficult to sort and filter sources that are not credible  Most of the health information on the internet is written above a 6 th grade reading level 25 Eichner, J., & Dullabh, P. (2007). Accessible health information technology (health IT) for populations with limited literacy: A guide for developers and purchasers of health IT. Rockville, MD: Agency for Healthcare Research and Quality.

THE DIGITAL AGE 26

Electronic Information and Digital Technology Use: By Age Among all American Adults, the Percent Who Use the Internet, by Age Perrin, A., & Duggan, M. (2015). Americans’ internet access: 2000–2015. Pew Research Center, Washington. Accessed at Pew InternetPew Internet 27

Electronic Information and Digital Technology Use: By Education Level Among all American Adults, the Percent Who Use the Internet, by Education Level Perrin, A., & Duggan, M. (2015). Americans’ internet access: 2000–2015. Pew Research Center, Washington. Accessed at Pew InternetPew Internet 28

Electronic Information and Digital Technology Use: By Income Among all American Adults, the Percent Who Use the Internet, by Income Perrin, A., & Duggan, M. (2015). Americans’ internet access: 2000–2015. Pew Research Center, Washington. Accessed at Pew InternetPew Internet 29

Electronic Information and Digital Technology Use: By Community Type Among all American Adults, the Percent Who Use the Internet, by Community Type Perrin, A., & Duggan, M. (2015). Americans’ internet access: 2000–2015. Pew Research Center, Washington. Accessed at Pew InternetPew Internet 30

Among all American Adults, the Percent Who Use the Internet, by Racial/Ethnic Group Perrin, A., & Duggan, M. (2015). Americans’ internet access: 2000–2015. Pew Research Center, Washington. Accessed at Pew Internet Pew Internet African Americans:  Report less internet use  Are less likely to have broadband access at home  Are more likely to own a smartphone 31 Electronic Information and Digital Technology Use: By Race/Ethnicity

 People use the internet to find health information 32 How People Access Health Information Online Fox, S., & Duggan, M. (2013). Health online Accessible at

How Online Health Information is Used  Find information on topics that are uncomfortable to discuss in person (i.e. sexuality, sexually transmitted infections/diseases, and HIV)  Supplement to traditional supports  Information must:  Be culturally tailored  Be actionable  Encourage user to seek care from a health professional 33

 Mobile phones are used to access health information  Health information must be responsively designed (mobile accessible) 34 Mobile Technology

SOCIAL MEDIA 35

Short messages (160 characters) sent between cell phones 36 Texting

 A social media platform in which text, images, videos, and other content are shared between people who mutually agree to be friends.  Users can subscribe to news from organizations’ Facebook Pages by liking them. 37 Facebook

 A social media platform in which users send and read short (140 character) messages called tweets.  To read messages, users follow other users in order to see the text, images, videos, and other content they share.  Twitter users can retweet (RT), spreading the message to users that follow them.  Tweets can be organized into conversations using a hashtag (#). 38 Twitter

 An online mobile photo- sharing, video-sharing and social networking platform in which users to take pictures and videos, and share them with their followers.  Content can also be shared with other social media platforms. 39 Instagram

 A video-sharing website that allows users to upload, view, and share videos  People and organizations can host channels in order to curate the content they post 40 YouTube

Snapchat  A photo and video messaging application in which users can take photos, record videos, add text and drawings, and send them to recipients from their cell phone contacts.  Content sent via Snapchat is called a snap. 41

Why Clients Use Social Media  Social media is not typically used as a place to find or share health information  People typically use social media to:  Stay in touch with friends and family  Connect with others that have shared hobbies or interests  Read comments by celebrities, athletes, or politicians  Find potential romantic or dating partners 42

Why Health Professionals & Organizations Should Use Social Media  Use new media for patient outreach and engagement  Promote your organization as a health literate organization  To engage with Black MSM 43

STRATEGIES TO ENGAGE YOUR AUDIENCE 44

General Tips for Using Social Media to Engage Your Audience  POST Method POST Method  People: define your target audience. Know your audience members needs and the tools they use.  Objectives: Know what you want to get out of your use of new media (listen to consumers, talk to consumers, support, energize)  Strategy: Know what you want to accomplish  Technology: Choose an appropriate technology to help you meet your goals 45

General Tips for Using Social Media to Engage Your Audience  Find and engage influencers  Create content once and reuse it often. Cross-post.  Let your audience determine the best technology to reach them; don’t let trends in technology drive your platforms  Embrace user-centered design  Measure progress towards your objectives  Be mindful of concerns about privacy on public pages 46

Best Practices for Text Messaging  Should be short and simply worded characters, including spaces and punctuation  Smartphones users can use voice-to-text or send audio notes via text message 47

Best Practices for Social Media  Vary the types of posts you use on social media  Use social media to spotlight information, news or events that help you connect to your clients. 48

Tips for Reaching Black MSM Online  Begin with the end in mind  Keep it short and simple  Not every social media network is essential for outreach  Invite input from your target population  Remember, having a presence on social media says to users you are open and receptive to candid conversations. 49

TIPS FOR DEVELOPING DIGITAL CONTENT FOR BLACK MSM WITH LIMITED HEALTH LITERACY 50

Tips for Developing Digital Content for People with Limited Health Literacy 1.Use plain and clear language  Use short and simple words  Explain unavoidable technical terms  Use short sentences  Write in active voice  Be consistent in word choice  Write at or below a 6 th grade reading level 51

Tips for Developing Digital Content for People with Limited Health Literacy 2.Write actionable content  Put the most important information first  Describe the health behavior – not just the basics  Provide specific action steps  Stay positive and realistic. Include the benefits of taking action  Check content for accuracy 52

Tips for Developing Digital Content for People with Limited Health Literacy 3.Ensure content is relevant to the intended audience  Make information relevant to consumers  Limit the number of messages  Make numbers or statistics easy to understand  Use graphics that clarify text 53

Tips for Developing Digital Content for People with Limited Health Literacy 4.Make the format conducive to reading and comprehension  Limit paragraph size.  Use bullets and short lists  Use meaningful headings and white space  Use a familiar 12-pt font  Keep the content in the center of the screen  Label links clearly  Use images that facilitate learning  Make sure your information is accessible to people with disabilities 54

Tips for Developing Digital Content for People with Limited Health Literacy 5.Ensure the content appeals to your target audience  Use culturally tailored and culturally sensitive content  Use graphics that are culturally appropriate and reflective of the target population 55

Tips for Creating a Health Literate Website 1.Organize content and simplify navigation  Create a simple and engaging landing page  Use labels that reflect words your users know  Enable easy access to home and menu pages  Make sure the “back” button works  Use linear information paths  Include simple search and browse options 56

Tips for Creating a Health Literate Website 2.Engage users with interactive content  Include printer-friendly tools and resources  Simplify screen-based controls and enlarge buttons  Include interactive content that users can tailor (but not too much)  Incorporate audio and visual features  Explore new media such as Twitter or text messaging 57

Tips for Creating a Health Literate Website 3.Test and revise based on user feedback  Review accessibility  Revise based on accessibility team review  Test with target audience  Revise based on feedback 58

RECAP 59

Recap of Module 6  Changing health landscape  Components of eHealth Literacy  Internet users  Access to the internet  New Media  Strategies to develop a social media presence 60

Knowledge Check 1.What are some tips you can use when writing digital content for people with limited health literacy? 2.What are some things to keep in mind when developing a health literate website? 61

Takeaway Activity 62  Ask your clients about their social media use.  Think about how you might structure outreach on one social media platform to reach your clients.  Come prepared to talk about your ideas.

Next Steps 63 In Module 7, participants will practice health literacy approaches they can use to foster client understanding and action. Participants will demonstrate how to check client understanding using the “Teach-back method” and present information that responds to the Ask Me 3™ approach.

Thank you! Trainer: Daniel Driffin Phone: This material was produced by John Snow Inc., under Contract #HHSH I with the Health Resources and Services Administration, U.S. Department of Health and Human Services.